Endocrine Flashcards
Hypothyroidism prev
5-8X more common in females
- over hypothyroidism : 0.1-2%
- subclinical hypo more common 4-10%
S&S of hypothyroidism
Galactorrhea 🥛 Pleural/ pericardial effusions Ascites Carotenemia Decreased hearing Enlargement of the tongue 👅
Drugs impairing thyroid function
Lithium 💊
- Amiodarone ♥️
Effect of dopamine on prolactin & TRH
Dopamine inhibits both prolactin and TRH ( so lowers TSH )
So dopamine ANTAGONIST will
⬆️⬆️ will increase the TSH 
Lowers serum TSH
Dopamine agonists, glucocorticoids, somatostatin ,
In early pregnancy 🤰 ( high level of chorionic gonadotropin )
High serum TSH?
Dopamine antagonist
Amiodarone
Adrenal insufficiency
Hashimoto’s thyroiditis
Pathological feature is lymphocytic infiltration,
- serological finding is high serum concentration of TPO and thyroglobulin 
Most bothersome symptom of hypothyroidism?
FATIGUE
Levothyroxine
The initial dose is 1.6mcg/Kg
For young healthy adult : u can start at 50
Elderly 🧓 start : low as 25 mcg
For short period of hypothyroidism like 2 months:
Take two-third of the anticipated dose
TIMING ⏱
- empty stomach
- before breakfast 🍳 30-60min
- TSH should be re-evaluated at 4-6 weeks
- if TSH above 🎯 target ? Increase dose by 25 mcg in older pt or higher young
- pt require repeat 🔁 TSH. 6 weeks
Factors that increase the requirement for T4 ( to increase the dose ⬆️🤩) 
- pregnancy 🤰
- Estrogen therapy
- taking med : phenytoin , carbamazepine
- malabsorption: IBD, celiac ,
- weight gain
- symptoms persists
Decrease in dose T4 may be required in the following setting
Normal aging
- weight loss more than 10%
- ANDROGEN therapy 🥴🥷🏼
Indication for non-pregnant adults with subclinical hypothyroidism ( T4 N , TSH⬆️) 
1- if the TSH >_10 ? Give T4💊
2- if TSH 7-9.9 ?
- age 65-75? GIVE. T4 💊
- age more than 65-75 ? If there is symptoms give !⚠️
3- TSH level upper limit of normal to 6.9 ?
- age 65-75 ? Observe ( tx not recommended bc normal aging ) ❌
- age less 65-75? If there is symptoms give T4 💊
Increase T4 requirements in pregnancy
As 🤰 early as 5th week
Management of hypothyroidism and pregnant women
TSH pregnant 🤰 specific ranges
1- if TSH upper normal limit - 2.5 ? Tx not indicated
2- TSH is 2.6-4 ? * 🎯 test for TPO
If +ve ; treat T4
Negative? No need
3-TSH >4 ?
🎯 next step check ( T4) 🟡
*T4 normal? Subclinical ? Give intermediate dose of T4
* T4 low ? Over ? Give Full dose
Diagnostic workup for hyperthyroidism
1- signs 🪧 & symptoms?
The. 2 - check TSH levels
🔻 if TSH low , T4 elevated
2- next do radioactive ☢️ iodine uptake & US
Radioactive iodine ☢️ uptake scan result
1- low uptake ?
- exogenous/ ectopic T4
- thyroiditis
2- high uptake ?
- homogeneous? Graves Dis🟣
- single nodule ( toxic adenoma) Plummer 🔨 syndrome
*toxic multinodeulor goiter
Mx of. Hyperthyroidism
Graves: mithmazole / PTU ,
Radioactive ☢️ iodine ablation
Thyroidectomy
Toxic adenoma/ multinodular goiter ?
Main treatment-option is surgery or ☢️ ablation ,
Medication 💊 will control but No hyperthyroidism remission
Thyroiditis
Usually transit SELF-limiting within 6️⃣ months .
Pain mx : NSAIDS ,
For adrenergic symptoms? BETA-blocker propranolol🔰
Mx of. Hypercalcemia
- normal saline
- loop diuretics
- Bisphosphonates ( ⚠️ caution of JAW osteonecrosis )
- calcitonin
- parathyroidectomy
Avoid ❌ ( thiazides)
Approach for hypercalcemiq ⬆️?
1- test Ca+
High ? 2- corrected Ca to ( confirmed hypercalcemia) 🔰
3- PTH level
- high ? Do 24hr URINE COLLECTION ( ca/Cr ratio)
- 🔻 high ratio ? 1* primary hyperparathyrodism
-🔻 low ratio ? FHH
- PTH level low ? 🪧 test for
@ PTHrp
@ Vit D 25
@ 1.25 Vit D
🟡 high 25 D level ? Vitamin toxicity
🟡 high 1-25 D ? Lymphoma , sarcoid
Management of adrenal insufficiency
Give hydrocortisone in a cute hypoadrenal crisis ⛔️⚠️
iF still hypotensive give fludrocortisone since it has the highest mineral glucocorticoids content, ⏱🔰
for stable nonhypertensive give predisone
Treatment of hyperaldosteronism
Solitary adenoma,: surgical resection 🔪
Hyperplasia ? Spironolactone
